The Ear

Causes

Normally air moves easily between outside and inside of the ear, sinuses, and lungs, helping to maintain a balance of pressure. Imbalances may be created with:

Sudden or severe changes in surrounding pressure

Blockages in the body's air cavities

The imbalance of pressure causes the air inside your body to shrink or swell. This is what can cause pain and damage.

Risk Factors

Activities that can expose someone to significant pressure changes include:

Airplane travel

Scuba diving,
particularly:

Ascending (going up to the surface) without exhaling freely

Swimming quickly to the surface when diving

Holding your breath when ascending

Underwater diving for an increased period of time

Repeated dives within 24 hours

Flying in an airplane after diving

Having air pockets in equipment (such as masks and dry suits)

Mechanical ventilation
—use of a machine to move air into and out of the lungs (associated with pulmonary trauma)

Exposure to shock waves from an explosion

The inner ear is connected to outside air through tubes to keep inner and outer pressure balanced. Blockages and congestion in these tubes increase the risk of ear barotrauma because the inside pressure is not allowed to change to match the outside pressure. These tubes may be blocked or limited by:

Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will be done to look for irritation or tissue damage. Barotrauma may be suspected based on your recent activities, such as air travel or scuba diving.

Treatment

Pulmonary barotrauma is serious and needs immediate medical attention. Treatment will depend on the specific lung problem that is present, such as a collapsed lung.

The following measures can also prevent barotrauma. Treatment options include the following:

Measures to Relieve Pressure

Pressure can be relieved with self-care and medications.

Self-Care

To relieve the pressure in the eustachian tube, you can:

Suck candy

Chew gum

Yawn

Inhale and gently exhale through your nose while pinching your nostrils shut. This forces air through the blocked eustachian tube and possibly opens it.

Medications

It is important to relieve nasal congestion and open your eustachian tube. Medications to relieve ear and sinus pressure include:

Decongestant nasal sprays

Oral decongestants

Oral antihistamines

Pain relievers can be used if ear or sinus pressure is causing pain. Antibiotics may be used if a bacterial infection is present or possible.

Emergency Care

Emergency medical care may include:

Surgery

Surgery may be necessary to relieve the pressure if your eustachian tube does not open with other treatments. Your doctor will make a small cut in your eardrum to equalize the air pressure. Any fluid blocking the tube may also be removed.

Oxygen Treatment

Oxygen should be given immediately for pulmonary barotrauma. The oxygen can be given through a mask over the face or by a tube under the nose.

Prevention

To help reduce your chance of barotrauma during:

Air Travel

If you can, postpone your flight if you have a cold or are congested. Use a decongestant if travel can not be delayed.

To relieve the pressure during take-off and landing, try:

Sucking candy

Chewing gum

Yawning

Breathing with your mouth open

Use filtered earplugs to slowly equalize the air pressure against your eardrum.

Avoid sleeping during descent because you may not be swallowing enough.

To help your baby through pressure changes, give your baby a pacifier or bottle during landing and take off.

Scuba Diving

Get proper training and certification.

Make sure all your equipment is working and vented properly.

Keep diving depth to level of experience.

Follow all breathing guidelines, especially when coming up from a dive.

Don’t stay under the water at greater depths long periods of time.

Avoid flying or going to a higher altitude for the next 24 hours after diving.

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.